Disentangling the relationship between cancer mortality and COVID-19 in the US

Sep 21, 2026

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Cancer is considered a risk factor for COVID-19 mortality, yet several countries observed stable cancer-coded deaths during the pandemic. This research clarifies the US population-level relationship between cancer mortality and COVID-19 by comparing pandemic-related mortality patterns using underlying-cause and multiple-cause death data for six cancer types plus diabetes and Alzheimer’s. Coding changes are addressed through multiple-cause analysis: in 2020, multiple-cause cancer mortality rose by ~3% versus baseline (~13,600 excess deaths). Increases were higher for less deadly cancers (2–7%) and minimal for lung and pancreatic cancers (0–1%). In contrast, multiple-cause deaths rose substantially for diabetes (37%) and Alzheimer’s (19%). Simulations indicate life expectancy differences explain these disparities, with deadly-cancer death risk outweighing COVID-19 risk.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages33

Reading Time1 h 23 min

AccessFree to download

Abstract

Introduction

Risk factors for COVID-19 mortality

Cancer as a potentially conflicting risk factor

RESEARCH ARTICLE *For correspondence: [chelsea.hansen@nih.gov](chelsea.hansen@nih.gov) Competing interest: The authors declare that no competing interests exist. Funding: See page 18 Sent for Review 30 November 2023 Preprint posted 03 January 2024 Reviewed preprint posted 28 February 2024 Reviewed preprint revised 16 July 2024 Version of Record published 27 August 2024 Reviewing Editor: Talía Malagón, McGill University, Canada This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Disentangling the relationship between cancer mortality and COVID-19 in the US Chelsea L Hansen1,2,3*, Cécile Viboud1, Lone Simonsen1,2 1 Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, United States; 2 PandemiX Center, Dept of Science & Environment, Roskilde University, Roskilde, Denmark; 3 Brotman Baty Institute, University of Washington, Seattle, United States | Abstract Cancer is considered a risk factor for COVID-19 mortality, yet several countries have reported that deaths with a primary code of cancer remained within historic levels during the COVID-19 pandemic. Here, we further elucidate the relationship between cancer mortality and COVID-19 on a population level in the US. We compared pandemic-related mortality patterns from underlying and multiple cause (MC) death data for six types of cancer, diabetes, and Alzheimer’s. Any pandemic-related changes in coding practices should be eliminated by study of MC data. Nationally in 2020, MC cancer mortality rose by only 3% over a pre-pandemic baseline, corresponding to ~13,600 excess deaths. Mortality elevation was measurably higher for less deadly cancers (breast, colorectal, and hematological, 2–7%) than cancers with a poor survival rate (lung and pancreatic, 0–1%) . In comparison, there was substantial elevation in MC deaths from diabetes (37%) and Alzheimer’s (19%) . To understand these differences, we simulated the expected excess mortality for each condition using COVID-19 attack rates, life expectancy, population size, and mean age of individuals living with each condition. We find that the observed mortality differences are primarily explained by differences in life expectancy, with the risk of death from deadly cancers outcompeting the risk of death from COVID-19. | | --- | | eLife assessment
This valuable work explores death coding data to understand the impact of COVID-19 on cancer mortality. The work provides solid evidence that deaths with cancer as a contributing cause were not above what would be expected during pandemic waves, suggesting that cancer did not strongly increase the risk of dying of COVID-19. These results are an interesting exploration into the coding of causes of death that can be used to make sense of how deaths are coded during a pandemic in the presence of other underlying diseases, such as cancer. | Introduction The dominant risk factors for COVID-19 mortality have consistently been shown to be advanced age, male gender, and certain chronic diseases such as diabetes, obesity, and heart disease (ChavezMacGregor et al., 2022; Rüthrich et al., 2021; Williamson et al., 2020) . Cancer has also been identified as a high-risk condition based on case-control and cohort studies, although these studies have provided conflicting results. In a large cohort study of ~500,000 COVID-19 inpatients, only cancer patients under recent treatment were at increased risk of COVID-19-related deaths (OR = 1.7) relative to non-cancer patients (Chavez-MacGregor et al., 2022) . Conversely, a smaller European study of 3000 COVID-19 inpatients found that cancer was not a risk factor (Rüthrich et al., 2021), as did an international, multicenter study of

FAQs

How does the study assess the link between cancer mortality and COVID-19 in the US?

It compares pandemic-related mortality patterns using underlying-cause and multiple-cause (MC) death data across six cancer types, as well as diabetes and Alzheimer’s.

What does the multiple-cause analysis show about cancer mortality in 2020?

Nationally in 2020, MC cancer mortality increased by about 3% over a pre-pandemic baseline, corresponding to roughly 13,600 excess deaths.

Why do the authors conclude that differences in excess mortality are mainly explained by life expectancy?

They simulate expected excess mortality using COVID-19 attack rates, life expectancy, population size, and mean age, and find observed differences align primarily with life expectancy, where deadly cancers’ death risk competes with COVID-19 risk.

Sep 21, 2026

Uploaded by Ezra